You're Right!

You are paying too much for healthcare! You’re not getting the quality you deserve, and are done accepting blind double-digit increases at renewal time. We’re here to help!

People-Centric
Organic Benefits
Financial Certainty

Why Transparency is Important

Transparency in healthcare costs is essential for employers to effectively manage their health plans and control expenses. While most people can easily tell you the cost of everyday items like bread, eggs, or gas, finding out the cost of healthcare services such as a doctor's visit, an MRI, or a CT-Scan is often challenging. Even calling a provider's office may not yield clear information on cash prices. This lack of transparency is due to the conditioning by big insurance and providers to only focus on individual cost-sharing, rather than the total cost. However, this mindset is costing organizations millions of dollars and needs to change in order to transform health plans for the better. 

Health insurance carriers lack transparency in several ways:

Complex billing and coding practices 

Limited access to pricing information 

Lack of clear cost estimates 

Limited information on in-network vs. out-of-network providers 

Confidentiality clauses in contracts 

This lack of transparency makes it difficult for clients and employers to manage healthcare costs and make informed decisions about health benefits.

HEALTH INSURANCE BROKERS

often receive compensation in the form of commissions and bonuses from insurance carriers, which may not be fully disclosed to their clients.

These compensation arrangements can include:

Commissions

Brokers may receive commissions from insurance carriers based on the premiums paid by their clients. These commissions are typically a percentage of the premium and can vary depending on the insurance carrier and the plan selected. 

Bonuses and incentives

Some insurance carriers offer brokers bonuses and incentives based on factors such as the volume of business they bring in, meeting sales targets, or selling specific insurance products. These bonuses and incentives may not always be fully disclosed to clients, and can create potential conflicts of interest for brokers. 

Contingent commissions

Some insurance carriers may also offer contingent commissions to brokers based on the overall profitability of the business they bring in. These contingent commissions are tied to factors such as claims experience, premium increases, and other financial metrics. Again, these commissions may not always be fully disclosed to clients and can impact the recommendations made by brokers. 

Non-monetary incentives

In addition to monetary compensation, insurance brokers may also receive non-monetary incentives from insurance carriers, such as gifts, trips, or other perks. These incentives can create potential conflicts of interest and may not always be disclosed to clients.

The lack of full disclosure of compensation arrangements can result in a lack of transparency for clients, as brokers may have financial incentives to recommend certain insurance products or carriers over others. It is important for clients to inquire about the compensation arrangements of their insurance brokers and ensure that they are receiving unbiased and transparent advice. 

Physicians may receive compensation through different methods

Including salary, fee-for-service, and RVU (relative value unit) compensation. These compensation methods can impact their total income and may create conflicts of interest for patient care. 

Salary:

Some physicians are employed by hospitals, clinics, or other healthcare organizations and receive a fixed salary regardless of the number of patients they see or services they provide. This can provide stability and remove financial incentives to overutilize services or see a high volume of patients. However, it may also create conflicts of interest if the employer places pressure on physicians to meet productivity targets or generate revenue for the organization. 


Fee-for-service:

In a fee-for-service model, physicians are compensated based on the number of services they provide, such as office visits, procedures, and tests. They may bill for each service separately, and their income is directly tied to the volume of services they deliver. This can create incentives to increase the volume of patients seen or services provided in order to generate more income. It may also result in overutilization of services, unnecessary testing, and potentially compromising patient care. 

RVU compensation:


RVUs (RELATIVE VALUE UNIT) are a system used to measure the relative complexity and resource utilization of different medical services. Physicians are compensated based on the RVUs associated with the services they provide. This can create incentives to perform high-RVU procedures or services, as they are typically reimbursed at a higher rate compared to low-RVU services. This may result in a focus on high-RVU services to maximize income, rather than prioritizing patient needs and appropriate care. 

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The volume of patients seen and RVU compensation can impact physicians' total income, and may create conflicts of interest that can potentially compromise patient care. For example, physicians may feel pressured to see a higher volume of patients or perform more procedures in order to meet productivity targets or generate more income, even if it may not be in the best interest of the patients. This can result in overutilization of services, unnecessary tests or procedures, and potential overbilling, which can negatively impact patient outcomes and increase healthcare costs. 

It is important for patients to be aware of the different compensation methods for physicians and how they may impact their care. It is also crucial for physicians to prioritize patient needs and adhere to evidence-based guidelines, rather than financial incentives, in order to ensure high-quality and patient-centered care. Healthcare organizations and policymakers should also consider the impact of compensation methods on patient care and work towards aligning incentives with the best interests of patients. 

The pricing of prescription medications is often opaque, with multiple stakeholders involved, including pharmaceutical manufacturers, pharmacies, health insurance carriers, and Pharmacy Benefit Managers (PBMs). PBMs are third-party entities that manage prescription drug benefits on behalf of health insurance plans and employers. However, PBMs have been criticized for their lack of transparency and how they profit at the expense of employers and employees. 

PBMs negotiate discounts and rebates with pharmaceutical manufacturers and pharmacies to determine the prices of prescription medications that are covered by health insurance plans. These negotiated prices are often complex, with various rebates, discounts, and fees involved, making it difficult for employers and employees to understand the true cost of medications. 

PBMs typically retain a portion of these discounts and rebates as their profit, which is not always disclosed to employers or employees. This lack of transparency can result in higher drug costs for employers and employees, as PBMs may prioritize their own profits over finding the best prices for medications. Additionally, PBMs may engage in practices such as "spread pricing," where they charge employers and employees a higher price for a medication than what they actually pay the pharmacy, pocketing the difference as profit. 

Furthermore, PBMs may also favor higher-priced medications that generate larger rebates or discounts, rather than lower-priced, equally effective medications, which can drive up overall drug costs. This can result in higher out-of-pocket expenses for employees and increased healthcare costs for employers. 

The lack of transparency in the pricing of prescription medications and the practices of PBMs can make it challenging for employers and employees to fully understand the true cost of medications and make informed decisions about their healthcare. It can also result in higher costs for both employers and employees, as PBMs may prioritize their own profits over finding the most cost-effective medications. As such, increased transparency and accountability in the pricing and reimbursement practices of prescription medications, including the role of PBMs, are important to ensure that employers and employees can access affordable and high-quality healthcare. 

You can think of operating expenses as the cholesterol in a business. Good cholesterol makes you healthy, while bad cholesterol clogs your arteries. Good operating expenses make your business strong, and bad operating expenses drag down your bottom line and prevent you from taking advantage of business opportunities. (Another name for bad operating expenses is “unnecessary bureaucracy.” Also “lard.” You can probably come up with others.) 

Harvard Business School Publishing
Financial Intelligence – A Manager’s Guide to Knowing What the Numbers Really Mean
Karen Berman, Joe Knight with John Case 2013 

Case Study

Benefixa Saves Ravn Alaska Over $1.3M in Healthcare Costs


Ravn Alaska - Northern Pacific Airways, a regional airline, is a lifeline for many Alaskans who rely on air travel to get home due to the vastness of Alaska and the natural barriers it poses. With the aim of improving the airline's operation, Ravn's CEO, Rob McKinney, turned to Benefixa for help in providing better medical and employee benefits for his team members. The decision was not easy, as healthcare is a critical aspect of people's lives. However, Rob knew that with the right decision, it would pay dividends for the organization. Benefixa was tasked with lowering healthcare costs while ensuring that the team members received the best medical care, which resulted in significant savings for the airline.

Read on to discover how Benefixa saved Ravn Alaska over $1.3M in 2022 and improved the medical coverage of the team members.

Customers served! $ 10000 Total Savings in 2022

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Our Process

It’s not easy; it’s complicated — For us, not you!
Engaging our services is simple and straightforward.

1.

CONNECT WITH US

At the core of our approach lies the essential practice of active listening. We genuinely value your organization and what truly matters to you. What motivates and excites your team? By gaining a deep understanding of these fundamental aspects, we can collaborate to create a customized solution.

In an ideal world, health insurance would provide peace of mind, acting as a robust safety net while ensuring seamless access to top-notch healthcare. We are eager to learn more about the coverage and plan designs you currently offer. What are the associated costs? Additionally, it would be helpful to understand the number of eligible individuals and the level of participation. Are your costs experiencing any changes—rising, falling, or remaining stable?

Similar to a skilled diagnostician, we recognize that prescribing the right solution requires a thorough understanding of the symptoms. This is why we encourage you to share more about yourself and your organization. Once we have a comprehensive picture, our team of experts will unleash their collective brilliance to serve you. Remember, the power of collaboration surpasses that of an individual.

Rest assured that our aim is to provide logical, friendly, and reassuring support throughout this process. We are committed to finding the best possible solution that aligns with your unique needs.

2.

COMPREHENSIVE ANALYSIS & ASSESSMENT

Once we grasp your goals, wants, and needs, we will present you with a clear picture of your current status compared to the national average, your projected trajectory, and the potential outcomes if we agree on the destination. There are various simultaneous solutions and strategies that can assist you in reaching your goals. 

3.

WE'VE GOT YOU COVERED

Think of Benefixa as an independent consultant you are hiring as a new elite team member because that's exactly who we are! We take pride in our honesty and transparency, and we offer a no-risk value proposition. When you engage us as your consultant, we put our compensation at risk based on your return on investment. Does your current broker offer a money-back guarantee? We do! 

Client Testimonials

I've been working with Benefixa for over a year now and have seen significant improvements in our healthcare outcomes. They truly understand our organization's needs and have delivered on their promises.

- John, CFO of a construction company.

As an HR professional, managing healthcare costs has always been a challenge. Since partnering with Benefixa, we've been able to reduce our costs and provide better care for our employees. I highly recommend them! 

- Sarah, HR Director of a manufacturing company.

We were struggling to keep up with increasing healthcare costs and knew there had to be a better way. Benefixa helped us transform our health plans and reduce costs, all while providing quality care for our employees. They truly exceeded our expectations. 

- Mike, CEO of a services company.

Life & Death Decisions in the C-Suite Featuring Ray Kober


Ray Kober
Benefixa CEO

About Benefixa

At Benefixa, we are dedicated to transforming healthcare for businesses and organizations across the United States. We understand the frustration of skyrocketing healthcare costs and the struggle to provide quality care for employees. Our team of experts has over 20 years of experience in insurance and has worked with clients ranging from small Mom and Pops to American Express.

We pride ourselves on doing what we say we'll do, when we say we'll do it, and have delivered results for our clients for years. We put our compensation at risk to ensure the best results for your organization.

Join us in fixing the broken healthcare system - we can do better, and we will.


See what Benefixa can do for you